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Exploring the Renal Angina Index in Pediatric Intensive Care: Correlations and Clinical Outcomes
Prachi Agarwal1, Dharm Raj Maurya2, Akshay Shukla3
1Department of Pediatrics, Baba Kinaram Autonomous State Medical College, Chandauli, Uttar Pradesh, India.
Insights
The renal angina index (RAI) effectively predicts severe acute kidney injury (AKI) in critically ill children. RAI outperforms serum creatinine in identifying children at risk for AKI in the pediatric intensive care unit.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Biomarker Research
Background:
- Acute kidney injury (AKI) in critically ill children is linked to poor outcomes.
- Early identification of children at risk for AKI is crucial for implementing nephroprotective strategies.
Purpose of the Study:
- To evaluate the predictive capability of the renal angina index (RAI) for severe AKI development.
- To assess RAI's accuracy at pediatric intensive care unit (PICU) admission for predicting severe AKI by day 3.
Main Methods:
- Included 152 children aged 2 months to 14 years.
- Monitored renal function tests and urine output for 3 days.
- Utilized Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI staging and ROC curve analysis.
Main Results:
- 30 (19.7%) participants developed severe AKI; 7 of these did not survive.
- RAI score >8 was significantly associated with mortality (P < 0.001).
- RAI demonstrated superior predictive performance (AUC=0.814) for severe AKI compared to serum creatinine (AUC=0.797).
Conclusions:
- RAI is a more effective predictor of severe AKI than serum creatinine alone in PICU patients.
- Further studies are recommended to validate these findings.
Introduction:
The development of acute kidney injury (AKI) in critically ill children is associated with adverse outcomes. Timely identification of children at risk for the development of AKI will help clinicians to apply nephroprotective strategies and improve outcome.
Objective:
The objective of the study was to assess the ability of renal angina index (RAI) at the time of admission in pediatric intensive care unit to predict the development of Severe AKI on day 3.
Methodology:
Children aged between 2 months and 14 years were included in study. Renal function test was measured at the time of admission and then subsequently every 24 hourly for 3 days, and urine output was measured every 6 hourly. AKI staging was done on day 3 according to the Kidney Disease Improving Global Outcomes criteria. Data were analyzed using SPSS version 21.0 and receiver operator characteristic curve analysis.
Results:
Out of 152 participants, 30 (19.7%) developed severe AKI in which seven did not survived. RAI score of >8 was significantly associated with mortality (P < 0.001). There was significant association between RAI score and development of severe AKI on day 3. RAI (area under the curve [AUC] =0.814, sensitivity (Sn) =73.3% and specificity (Sp) =72.1%) outperformed day 1 serum creatinine (AUC = 0.797, Sn = 66.7% and Sp = 83.6%) as a marker of development of severe AKI on day 3.
Discussion:
RAI is better when compared to serum creatinine alone for the development of severe AKI.
Conclusion:
RAI performs better than serum creatinine for prediction of severe AKI in PICU patients, however further studies are needed for validation.
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